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Benzodiazepine antagonist
Aka: Benzodiazepine antagonist, Flumazenil, Romazicon
- Indication
- Benzodiazepine sedation reversal
- Contraindications
- Mixed drug Overdose with compounds that may cause Seizure (e.g. Tricyclic Antidepressants, Cocaine)
- Chronic Benzodiazepine use (dependence)
- Seizure Disorder
- Dosing: Adults
- Benzodiazepine Sedation Reversal
- Initial: 0.2 mg IV over 15 seconds
- Titrate: 0.2 mg each minute to 1 mg total
- Overdose Reversal
- Initial: 0.2 mg IV over 30 seconds
- Titrate: 0.3-0.5 mg q30 seconds to 3 mg total
- Repeat dosing protocol
- Repeat Dose: 0.005 mg/kg q1-2 minutes
- Maximum cumulative dose: 1 mg
- May repeat regimen every 20 minutes
- Dosing: Children
- Initial: 0.005 to 0.2 mg IV over 3-5 minutes, titrating to effect
- Precautions
- Avoid in patients with chronic use (risks of severe withdrawal including Seizures)
- Most toxicology guidelines do not recommend Flumazenil in Overdose
- Potential harms appear to outweigh benefits in most cases
- Penningo (2016) Basic Clin Pharmacol Toxicol 118(1): 37-44 +PMID:26096314 [PubMed]
- May cause acute withdrawal if physically dependent
- Do not give routinely to comatose patients
- Only use if identity of drug is known, and certain that the patient has not used chronically
- Reverses Seizure protection of Benzodiazepines
- Increases risk of drugs that lower Seizure threshold (Cocaine, Tricyclic Antidepressants)
- Pharmacokinetics
- Onset: 1 to 2 minutes
- Peak: 6 to 10 minutes